"The Misfit" by Steven Poser

Kindle edition here.

• "You can imagine how difficult it is treating a Hollywood actress, who has so many serious problems and is completely alone in the world, and yet at the same time is extremely famous." 

• "She was so childlike she could do anything, and you would forgive as you would forgive a seven-year old. She was both a woman and a baby, and both men and women adored her." 

• "As she becomes more anxious, she begins to act like an orphan, a waif, and she masochistically provokes them to mistreat her and take advantage of her. As fragments of her past history came out, she began to talk more and more about the traumatic experiences of an orphan child."
• "Kris did to her what her mother had done - gave her away, abandoned her to be looked after by somebody else. And what made this all the more terrible was that this pioneer child analyst had most probably treated her with all the loving kindness and maternal care that was part of her conception of the treatment as a kind of re-mothering that she rightly understood was Marilyn’s most basic emotional need. But in the moment of crisis, she put her into a psychiatric ward, entrusting her to the care of “two idiot doctors,” provoking Marilyn’s primal fear that she would fall prey to the very madness that befell both her mother and her grandmother. It was a repetition of her deepest trauma and it triggered the most profound anxieties"
• "He was moved by the pathos of her early life. This was really a matter of life and death. She had tried to kill herself before. She was using an enormous quantity of narcotics and barbiturates, several of which she took intravenously. He was dealing with a psyche so fragile if could fall apart at any time."
• "Greenson moved from noting symptoms of paranoia and “depressive reaction” to observing signs of schizophrenia. In the end, after her death, he described her as a woman with “extremely weak psychological structures . . . ego weakness, and certain psychotic manifestations, including those of schizophrenia.”    All of this made Marilyn an unsuitable candidate for psychoanalysis. In his book, Greenson clearly rules out the schizophrenic, borderline, and psychotic patient from analytic therapy. “these patients were not suitable for psychoanalysis because they could not bear the deprivation which classical psychoanalysis demands,” he wrote. “Man is not able to endure aloneness very well for any considerable period of time. The analytic situation mobilizes tho antithetical sets of reactions. The sensory isolation of the patient on the couch stirs up feelings of aloneness, frustration, and the hunger for object relations. On the other hand, the high frequency of visits, the long duration of the treatment, and the devotion to the patient’s needs stirs up memories of the early closeness between mother and child.” Marilyn was just too damaged, deprived, psychologically immature and emotionally needy to take it."
• "the schizophrenic or psychotic patient has no coherent internal representation of herself or of significant people external to her. She has lost these representations through some traumatic regression or breakdown, or perhaps never developed them in the first place due to emotional deprivation at critical juncture in the infolding of her mind. There is thus a terrible void that the psychotic strives to fill by creating new objects, but these are unstable, fragmentary parts and pieces of herself and others. “As a consequence of this theory,” they wrote, “we believe that treatment must focus on efforts to restore object constancy and therefore frequently must begin in the real relationship between the schizophrenic patient and his therapist. The sicker the patient, the more defects, maturational deficiencies, failure to develop good whole object relations, the greater is the need to establish and maintain a real object relationship."
• "She was seeing Greenson almost every day. Her sessions would sometimes last four or five hours. “I had become a prisoner of a form of treatment that I thought was correct for her, but almost impossible for me,” he said. “At times I felt I couldn’t go on with this.”
• "she (Marilyn) did suffer psychotic, as opposed to neurotic anxieties, and her defenses against these were very primitive, putting her into states which rendered her unable to think and prone to obliterating herself. One of the central criteria defining the borderline personality is a profound disturbance of identity. Borderlines lack a stable, core sense of who they are. Their sense of self is diffuse and constantly in danger of dissolving into nothingness. The borderline needs to recreate herself continuously because there is nothing reliably and continually there to hold on to."
• "Neurotic anxiety is ultimately a fear of losing the loved object. A forbidden wish wants to come out of the unconscious, and the repression of that wish expresses itself in a fear of punishment, guilt, or humiliation. By contrast, psychotic anxiety is ultimately a fear of losing the self, of falling apart, of being rendered mindless, of annihilation. It is a nameless dread; it has no object. It is a fear of falling forever into the void."
• "These dissociative states are also those in which the borderline will self-mutilate, subject herself to masochistic exploitation of some kind, abuse drugs, and engage in other forms of acting out the wish to just not have to bear the burden of consciousness. This includes suicidal behavior as the ultimate form of self-annihilation."